What to do?? IM won't come out of the hole!

[docpsychrn42, ASN, RN]

i have a question....we have an inmate that is on suicide watch in our facility. he does not want to come off suicide watch because he will have to go to the hill. so, everytime we see him (the psychiatrist and myself) he says he will kill himself if we take him off suicide watch or try to make him go back in general pop. there is no documentation from the outside that states that this im has or has not attempted suicide in the past, he is the only person telling us that he has. he has not done one thing while he's been in the hole in an attempt to harm himself. when we see him, he laughs, jokes and demands higher doses of psych meds. if we talk to him about returning to the hill, he immediately states that if we do, he will kill himself no matter what. he does not want pc and will not ask for it. he simply wants to stay on suicide watch so that he doesn't have to leave. problem is, we want to transfer him to a camp that specializes in mental health issues but we cannot transfer him as long as he is on suicide watch! we have even told him that if he gets off suicide watch he can go to this special camp, he states that he will kill himself if we take him off. does anyone have any ideas as to what to do? i have been a mental health nurse for 23 years and for the life of me can't come up with an answer as to what to do. if we were in a forensic hospital setting, this would be a no brainer, but we aren't. and he doesn't qualify for a transfer to a forensic hospital stay either. he is more an axis ii than anything. any suggestions as to what to do? we are getting it from all directions in the sense that they want this guy out of the hole but we aren't putting our licenses' on the line if this guy decides to follow through on his threats.

[Sheri257]

In my facility, the psych doctors are pretty good about not letting the inmates manipulate with suicide threats.

We get suicide threats all the time ... when it's obvious that the inmate is not suicidal and is using the suicide threat to dictate his housing assignment, we amply document that the inmate is not demonstrating suicidal behavior and that's it ... he's moved.

In some cases, we've even written up inmates for staff manipulation because we can't have these malingerers hogging limited mental health crisis beds which are in such short supply as it is.

So far, none of these guys have actually committed suicide ... at least that I've seen. Some will do superficial cuts just to try to scare us but, even then, we don't change their housing because ... if we indulged all of their demands ... we'd never have enough beds for the truly ill inmates.

In the end, the focus has to be on the inmates who are really sick.

[JailRN]

First and foremost, protect your license!!!

You will be cricified if he does carry out his threat. Let him stay in the hole. Does he have ANYTHING that points to autism?? (Usually, they don't play well with others in the sandbox and do much better, and prefer to be alone.)

I'd let him stay.

[lytlbyt]

I worked in corrections for 3 years... loved it!! But I will tell you... stay completely out of it medically. The mental healt professionals are the ones that should assume that responsibility. I had a person in a jail commit suicide on my shift. The inquest into that was horrible. They dug in to all of the interventions that should have been done. Fortunately the nursing staff was cleared of liability since the person never told any one of us that he was contemplating suicide. He pretty much didn't tell anyone.

Over the 3 years I worked in corrections there were so many people that threatened suicide and if nursing staff got involved it made things more complicated since they want to do nothing but manipulate you and the system. He will eventually be cleared.... he will give in and if not... that's his issue because then he will be lacking in the social department and be kept alone and with nothing....

Just my experience...

Good luck!!

[hcmanp, NP]

I worked in corrections for 3 years... loved it!! But I will tell you... stay completely out of it medically. The mental healt professionals are the ones that should assume that responsibility. I had a person in a jail commit suicide on my shift. The inquest into that was horrible. They dug in to all of the interventions that should have been done. Fortunately the nursing staff was cleared of liability since the person never told any one of us that he was contemplating suicide. He pretty much didn't tell anyone.

Over the 3 years I worked in corrections there were so many people that threatened suicide and if nursing staff got involved it made things more complicated since they want to do nothing but manipulate you and the system. He will eventually be cleared.... he will give in and if not... that's his issue because then he will be lacking in the social department and be kept alone and with nothing....

Just my experience...

Good luck!!

Use the Nacho theory - if it's nacho problem, don't take it on! Leave it to MH

[Sheri257]

You will be cricified if he does carry out his threat. Let him stay in the hole.

Based on the above information, this inmate is not demonstrating suicidal behavior. You're basically letting the inmate manipulate the situation and, when you allow manipulation, it will never end. So ... what happens? Most of your time is wasted on the manipulators when you should be paying more attention to the inmates who are really sick.

In prison, like anywhere else, the squeaky wheels get the grease ... and that's the real problem. In my experience ... the inmates who complain the most, threaten this or that ... aren't actually the sickest inmates. The sickest inmates typically are the ones you don't hear much from but, that's actually where your license is most at risk.

Statistically, very few inmates actually commit suicide. Inmates are much more likely to die from chronic conditions like asthma, heart disease, etc ... and too often it's due to medical neglect of some kind because too much of our time and resources are wasted on the manipulators.

The guys I really worry about are the older inmates who, at least in my experience, rarely complain until they reach critical conditions. We had one older inmate who died from a heart attack and he rarely complained.

But ... that's where you get the most deaths and, consequently, the most investigations. So I spend more of my time on the chronically ill inmates ... making sure they're getting their meds, doctors appointments scheduled, breathing treatments, etc. Because there's a much greater chance of that coming back on my license ... rather than some inmate who's using suicide threats to dictate housing assignments.

Sure ... I refer them to the psych doctor if they cut themselves. And I have had guys cut themselves alot but, if the MD decides they're manipulating ... we patch up their cuts and that's it. I don't waste any more time on them once they're cleared by psych.

And a funny thing happens ... when you stop rewarding the manipulative behavior, the inmates quit the behavior ... which frees up your time for the inmates who really need medical attention.